The following is a recap of some of the provisions impacting employer plans for plan years beginning on or after January 1, 2014. Please note this lists summarizes new or revised requirements; please see your Compliancedashboard for a complete list of employer compliance requirements.
Plan Provision Updates
Annual Limits: Currently restricted annual limits will be eliminated.
Resource: ACA: Lifetime and Annual Limits
Waiting Periods: Cannot exceed 90 calendar days, which can start after substantive eligibility conditions have been met.
Resources: Waiting Periods, Blog and IRS Notice 2012-58
Pre-existing Conditions: Eliminate the application of pre-existing condition exclusions in group health plans and health insurance coverage.
Resource: HIPAA Plan Portability
Dependent Coverage (GP): Previously exempted, grandfathered plans that offer dependent coverage must cover children under age 26 who are eligible for coverage under another employer’s plan.
Resource: Health Care Coverage for Adult Children
Cost Sharing (NGP): Limit Out-Of-Pocket (OOP) Maximums to $6,350 (individual) and $12,700 (family). Plans with multiple administrators may be eligible for transitional relief.
Resources: ACA:NonGrandfathered and Blog
Clinical Trials (NGP): Group health plans must provide coverage (and may not limit) coverage for individuals participating in clinical trials.
Resource: FAQ
Small Group Market Only (Insured)
Cost Sharing (NGP): Limit deductibles to no greater than $2,000 (individual) and $4,000 (family). Limits are subject to an annual adjustment after 2014.
Resource: ACA: Non-Grandfathered
Essential Health Benefits (NGP): Plans must provide Essential Health Benefits that are equal in scope to benefits covered by a typical employer plan as determined by each state and must include items and services in ten general categories.
Resource: Essential Health Benefits
Disclosures, Fees and Administration
Summary of Benefits and Coverage (SBC): The Departments issued a new template for coverage on or after Jan. 1, 2014. The SBC must be provided with open enrollment materials or on the first date an employee is eligible to enroll in coverage.
Resources: SBC: Self-Insured Plans and SBC: Fully Insured Plans
Reinsurance Payments: Annual fee to subsidize high cost participants in the individual market. Paid by plan sponsors of self-insured plans and insurers of fully insured plans. Contributing entities must submit enrollment data to HHS by November 15 each year (generally calculated based on January through September data, even for non-calendar year plans).
Resource: Blog
Play or Pay Penalty: Although delayed until 2015, large employers with variable hour employees should take steps to calculate hours in determining which employees are considered full-time under the ACA guidelines.
Resource: Shared Responsibility for Employers
Same-Sex Spouses: Same-sex spouses (married in a jurisdiction that recognizes same-sex marriages) must be treated the same as opposite-sex spouses with respect to, among other things, COBRA, special enrollment rights and the ability to pay health benefits on a (federal) pre-tax basis.
Resource: Blog-Health Plans and Blog-401(k) Plans
Wellness Incentives: Employers can offer incentives up to 30% of the cost of coverage (up from 20%) to participate in a wellness program.
Resource: Wellness Rules
$500 Carryover for Health FSAs: Employers can adopt a rule allowing employees to carryover up to $500 from the previous year in their FSA. This provision cannot be used in conjunction with a 2 ½ month grace period.
Resource: Health FSA Amendment
Mid-Year Election Changes for Non-Calendar Year Cafeteria Plans: Transitional relief allowing amendments to non-calendar-year cafeteria plans enabling employees to stop or begin salary reductions to allow purchase of employer coverage or exchange coverage. Transitional relief is only available for the plan year beginning in 2013.
Resource: Cafeteria Plan Changes Under ACA
HRA, Cafeteria Plans and FSA Compliance Under the ACA: Employers cannot offer pretax account arrangements that employees use to purchase individual health coverage (unless those plans do not have annual or lifetime limits). Note that this does not apply to stand-alone retiree-only HRAs.
Resources: Blog and Account-Based Plans
GP = Grandfathered Plans
NGP = Non-Grandfathered Plans